Provider Demographics
NPI:1609631803
Name:COLUMBUS EAST SENIOR LIVING LLC
Entity Type:Organization
Organization Name:COLUMBUS EAST SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:THIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-715-3213
Mailing Address - Street 1:1466 MANNING PKWY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9171
Mailing Address - Country:US
Mailing Address - Phone:614-715-3213
Mailing Address - Fax:
Practice Address - Street 1:79 BLOSSOM FIELD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3076
Practice Address - Country:US
Practice Address - Phone:614-530-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility